Clinical Presentation, Laparoscopic Findings, and Therapeutic Aspects of Endometriosis in Patients Undergoing Laparoscopy at the Yaoundé Gyneco-Obstetric and Pediatric Hospital

Introduction: Endometriosis is a chronic gynecological disease defined as the presence of endometrial tissue outside the uterine cavity. It affects approxi- mately 10% of women of childbearing age worldwide. It is a public health issue characterized by severe pain and infertility that negatively impacts the qual- ity of life of affected patients. Laparoscopy plays a pivotal role in its diagnosis and surgical management. However, access to this minimally invasive tech- nique remains limited to a few specialized hospital centers, inc luding the Ya- oundé Gyneco-Obstetric and Pediatric (YGOPH). This study aimed to evalu- ate the clinical, laparoscopic, and therapeuti c aspects of endometriosis in pa- tients undergoing laparoscopic surgery at YGOPH. Methodology: This was a descriptive cross-sectional study with retrospective data collection over a five- year period from January 2018 to July 2023, conducted in the Gynecology De- partment of YGOPH. We included patients with complete medical reco rds who underwent laparoscopy and were diagnosed with endometriosis lesi ons. Disease staging was performed using the revised American Society of Repro- How to cite this pap er: Tompeen, I., Kenmogne, S., Ngaha, J., Batoun, V.M., Meka, E., Mpono, P., Sama, D. and Pascal, F. (2025) Clinical Presentation, Laparo- scopic Findings, and Therapeutic Aspects of Endometriosis in Patients Undergoing Laparoscopy at the Yaoundé Gyneco-Ob- stetric and Pediatric Hospital. Open Jour- nal of Obstetrics and Gynecology, 15, 1748- 1762. https://doi.org/10.4236/ojog.2025.1510148 Received: August 21, 2025 Accepted: October 26, 2025 Published: October 29, 2025 I. Tompeen et al. DOI: 10.4236/ojog.2025.1510148 1749 Open Journal of Obstetrics and Gynecology ductive Medicine (rASRM) classification. Data were analyzed using IBM SPSS Statistics version 26, and results were expressed as the mean, frequency, and percentage. Results : Among 413 women who underwent laparoscopic s ur- gery, 71 were diagnosed with endometriosis lesions, accounting for 17.2 % of cases. The average age was 31.9 ± 5 years, and the average age at menarche was 12.28 ± 2.08 years. Nulliparous women accounted for 61% of cases . The most common clinical symptoms were chronic pelvic pain (53%) and infertili ty (59.4%). Pelvic ultrasound was the most frequently performed imagin g study (53%). The primary surgical indications were infertility ( 34%), chronic pelvic pain (19%), and ovarian cysts (17%). Regarding laparoscopy, superficial e n- dometriosis was the most prevalent phenotype (67%), with the ovary being the most affected organ (75%). The uterosacral ligaments were the most fr equent location of deep lesions (65%). According to the rASRM, endometriosis was severe in 52% of cases. Surgically, endometriomas were systematically drained, followed by cyst wall excision in all cases. Superficial lesions were ablated b y fulguration in 40.5% of cases. Conclusion : The prevalence of endometrio sis among women undergoing laparoscopic surgery was 17.2%. This condition pri- marily affected young, infertile women with chronic pelvic pain. Superficial en- dometriosis was the most common phenotype, with surgical management tai- lored accordingly.

Endometriosis, Clinical Presentation, Laparoscopy, Treatment, YGOPH 1. Introduction Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. It is a chronic gynecological disease that affects approximately 10% of women of childbearing age worldwide [1] . Often associated with severe pelv ic pain, dys- menorrhea, dyspareunia, and infertility, endometriosis significantly impacts pa- tients’ quality of life and represents a considerable socioeconomic burden [2]. Man- aging endometriosis is complex and involves medical and surgical approaches. Surgery is often recommended for severe or medically resistant cases. La paros- copy, a minimally invasive surgical technique, is now considered the go ld stand- ard for both diagnosis and treatment of endometriosis, offering advantages such as smaller incisions, faster recovery, and less post-operative pain compared to lap- arotomy [3]. In the African context, particularly in Cameroon, endometriosis management faces specific challenges. Diagnosis is often delayed due to limited public awar e- ness, restricted access to specialized diagnostic tools (experts on endometrios is, ultrasound, and MRI), and cultural normalization of pelvic pain in wome n [4]. Consequently, patients often present at advanced disease stages with extensive, complex lesions. Furthermore, although laparoscopy is the preferred surgical ap- Copyright © 2025 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access I. Tompeen et al. DOI: 10.4236/ojog.2025.1510148 1750 Open Journal of Obstetrics and Gynecology proach for endometriosis, its availability in Cameroon is predominantly limi ted to major urban centers. Key barriers include: high equipment cost, shortage of trained specialists, and insufficient surgical training progr ams in advanced lap- aroscopic techniques [5]. As a referral center, the Yaoundé Gyneco-Obstetric and Pediatric Hospital (YGOPH) plays a central role in managing complex gynecologi- cal conditions, including endometriosis. This study aims to describe the clinical, laparoscopic, and therapeutic aspects of endometriosis in women who underwent laparoscopic surgery at YGOPH. This research will improve our understanding of the disease’s specific characteristics in the Cameroonian clinical context, identify challenges in diagnosis and surgical man- agement, and suggest ways to improve the care of women with endometriosis i n Cameroon. 2. Methodology 2.1. Study Design We conducted a descriptive, cross -sectional study with retrospective data collec- tion over a five-year period from January 2018 to July 2023 in the gynecology de- partment of YGOPH. 2.2. Study Population We included all patients with complete medical records who underwent laparos- copy during the study period and were diagnosed with endometriosis. For each case, sociodemographic, clinical, paraclinical, and intraoperative data were coll ected. We used the revised American Society of Reproductive Medicine ( rASRM) score to stage the disease. 2.3. Data Analysis Data were analyzed using IBM SPSS version 26 software, and results were pre- sented in tables and figures. Parameters of central tendency (mean and median) and dispersion (standard deviation and interquartile range) were used to describe quantitative variables. Qualitative variables were expressed as absolute or relative frequencies. 2.4. Ethical Considerations This study was approved by the ethics committees of the Faculty of Medicine and Biomedical Sciences at the University of Yaoundé 1 and YGOPH. The anonymity and confidentiality of the collected data were maintained. 3. Results During the study period, 413 patients underwent laparoscopy. Among them, 71 were found to have endometriosis lesions, of whom seven patients were excluded due to missing medical records. The participant flow chart is as follows ( Figure 1). I. Tompeen et al. DOI: 10.4236/ojog.2025.1510148 1751 Open Journal of Obstetrics and Gynecology Figure 1 . Participant flow diagram. 3.1. Prevalence of Endometriosis in Patients Undergoing Laparoscopic Surgery Of the 413 patients who underwent laparoscopic surgery during the study period, 71 had endometriosis lesions, representing a prevalence rate of 17.2%. 3.2. Sociodemographic Characteristics Table 1 . Sociodemographic characteristics of the patients. Characteristics N = 64 % Age Means ± SD 31.9 ± 5 Range 20 - 43 [20 - 24] 5 7.8 [25 - 29] 13 20.3 [30 - 34] 27 42.2 [35 - 39] 14 21.9 >40 5 7.8 Parity Nulliparous 39 60.9 Pauciparous 10 15.6 Primiparous 14 21.9 Multiparous 1 1.6 Marital Status Single 40 62.5 Married 24 37.5 I. Tompeen et al. DOI: 10.4236/ojog.2025.1510148 1752 Open Journal of Obstetrics and Gynecology Continued Place of Residence Urban 59 92.2 Rural 5 7.8 Education Level Secondary 20 31.2 Higher Education 44 68.8 Occupation Civil Servant 17 26.6 Private Sector 15 23.4 Informal Sector 7 10.9 Student 14 21.9 Unemployed 11 17.2 The age range was 20 to 43 years old, with an average age of 31.9 ± 5.0 years. The most represented age group was 30 to 34 years old (42.2%). Most of the patients were nulliparous (60.9%), single (62.2%), highly educated (68.8%), and lived in urban areas (92.2%) (Table 1 ). 3.3. Clinical and Paraclinical Characteristics of Patients Table 2 summarizes the clinical characteristics of patients. Table 2 . Clinical characteristics of the patients. Characteristics N = 64 % Menarche Means ± SD 12.28 ± 2.08 Medical History Curettage 11 17.2 Cesarian Section 2 3.1 Myomectomy 6 9.4 Hysteroscopy 2 3.1 Cervical Stenosis 1 1.6 Infertility Primary 22 34.4 Secondary 16 25 Chronic Pelvic Pain Non-cyclical 16 25 Cyclical 18 28.1 Dyspareunia 23 35.9 I. Tompeen et al. DOI: 10.4236/ojog.2025.1510148 1753 Open Journal of Obstetrics and Gynecology Continued Dyschezia 1 1.6 Menorrhagia 3 4.7 Abdominal Distension 1 1.6 Adnexal Mass 19 29.7 Uterosacral Ligament Induration 10 15.6 Abdominal tenderness 6 9.4 Fixed Uterus 6 9.4 Umbilical Nodule 3 4.7 Retroverted Uterus 3 4.7 Surgical Indications Infertility 22 34.4 Chronic Pelvic Pain 21 32.8 Ovarian Cysts 11 17.2 Post-myomectomy Laparoscopy 3 4.7 Unruptured Ectopic Pregnancy 3 4.7 Uterine Fibroid 1 1.6 Tubo-Ovarian Abscess 1 1.6 Suspected Ovarian Cancer 1 1.6 Adnexal Torsion 1 1.6 The average age at menarche was 12.28 ± 2.08 years. A history of curettage and myomectomy was found in 17.2% and 9.4% of cases, respectively. Patients were infertile in 59.4% of cases and reported chronic pelvic pain (53.1%), which was mostly cyclical. Dyspareunia was present in 35.9% of cases. The most common physical signs were the perception of an adnexal mass dur- ing a vaginal examination (29.7%) and induration of the uterosacral ligame nts (15.6%). The main reasons for surgery were infertility (34.4%), chronic pelvic pain (32.8%), and ovarian cysts (17.2%). Table 3 summarizes the paraclinical characteristics of the patients. Serum CA 125 testing was requested for nine patients (14%) as part of the inves- tigation of an ovarian cyst. The test results were elevated in more than three-quar- ters of the cases. Pelvic ultrasound was the most commonly performed morphological examina- tion (53.1%). The main ultrasound finding was ovarian cysts (61.8%), and endome- triosis was suspected in three patients. Kissing ovaries were identified on ultrasound in two patients. I. Tompeen et al. DOI: 10.4236/ojog.2025.1510148 1754 Open Journal of Obstetrics and Gynecology Table 3 . Paraclinical characteristics of the patients. Characteristics N = 64 % CA125 Level 9 14 Elevated CA125 7 10.9 Pelvic Ultrasound 34 53.1 Ovarian Cyst 21 32.8 Kissing ovaries 2 3.1 Ascites 1 1.6 Pelvic MRI 11 17.2 Retrocervical Endometriosis 5 7.8 Kissing ovaries 2 3.1 Adenomyosis 2 3.1 3.4. Clinical and Intraoperative Characteristics of Patients Table 4 summarizes these characteristics. Superficial endometriosis lesions were the most frequent (67.2%). Pelvic adhesions were present in 84.4% of cases. The ovary was the most commonly affected organ (75%), followed by the utero- sacral ligaments (45.3%). The most common primary lesions of superficial endometriosis were blue lesions (34.4%). Table 4 . Characteristics of Endometriosis Lesions. Characteristics N = 64 % Endometriosis Phenotype Superficial Endometriosis 43 67.2 Endometrioma 34 53.1 Deep Infiltrating Endometriosis 34 53.1 Superficial Endometriosis Appearance Blue 22 34.4 Retraction 15 23.4 Stellate Lesion 9 14 Red 8 12.5 Cystic Nodule 7 10.9 White 5 7.8 Black 3 4.7 Hypervascularization 3 4.7 Brown 1 1.6 Yellow 1 1.6 Endometrioma Location Left Ovary 7 10.9 Right Ovary 10 15.6 I. Tompeen et al. DOI: 10.4236/ojog.2025.1510148 1755 Open Journal of Obstetrics and Gynecology Continued Bilateral 17 26.6 Deep Infiltrating Endometriosis Sites Uterosacral Ligaments 22 34.4 Torus Uterinum 10 15.6 Rectovaginal Septum 12 18.7 Rectum 1 1.6 Overall Affected Organs Sigmoid Colon 2 3.1 Appendix 2 3.1 Rectum 4 6.3 Bladder 4 6.3 Diaphragm 5 7.8 Ovarian Fossa 5 7.8 Pouch of Douglas 7 10.9 Abdominal Wall 10 15.6 Rectovaginal Septum 12 18.7 Torus Uterinum 14 21.9 Fallopian Tube 16 25 Uterus 21 32.8 Uterosacral Ligaments 29 45.3 Ovaries 48 75 Adhesions (According to AFS Classification) 54 84.4 Type A (Filmy) 11 17.2 Type B (Dense Avascular) 44 68.7 Type C (Opaque) 16 25 Endometriomas were bilateral in half of the cases (26.6%). When unilateral, the right side was most commonly affected. The uterosacral ligaments were the most common site of deep endometriosis le- sions (64.7%). Figure 2 illustrates the distribution of endometriotic lesions based on their se- verity according to the rASRM classification. Figure 2 . Revised American Society of Reproductive Medicine (rASRM) classification of endometriosis. I. Tompeen et al. DOI: 10.4236/ojog.2025.1510148 1756 Open Journal of Obstetrics and Gynecology According to the revised classification of the American Society of Reproductive Medicine (rASRM), most patients (51.6%) had severe endometriosis. Table 5 summarizes the surgical procedures per formed to treat endometriotic lesions. Table 5 . Surgical management of endometriotic lesions. Characteristics N = 64 % Adhesiolysis 54 84.4 Complete Adhesiolysis 45 83.3 Incomplete Adhesiolysis 9 16.7 Endometrioma Management 34 53.1 Cyst Drainage 34 100 Cyst Wall Excision 34 100 Superficial Endometriosis Management 37 57.8 Ablation (Fulguration) 15 40.5 Excision 12 32.4 Combined (Fulguration + Excision) 10 27.1 Deep Infiltrating Endometriosis Management Retrocervico-Rectal Shaving 12 18.7 Resection of Uterosacral Ligaments 22 34.4 Additional Procedures Appendectomy 1 1.6 Umbilical Nodulectomy 3 4.7 Tuboplasty (Fimbrioplasty/Salpingostomy) 30 46.9 Adhesiolysis was completed in the majority of cases (83.3%). Endometriotic cysts were systematically drained, followed by cyst wall excision in cases. The most common procedure for superficial lesions was ablation by fulguration (40.5%). Resection of the uterosacral ligaments was the main procedure for deep lesions. Retro-cervico-rectal shaving was performed for retro-cervico-rectal lesions. 4. Discussion The main objective of this paper was to study the clinical , laparoscopic, and ther- apeutic aspects of endometriosis in women undergoing surgery at the YG OPH. More specifically, the aim was to determine the frequency of endometriosis in the study population, to describe the sociodemographic, clinical, and para -clinical characteristics of the participants, to identify the different indications for laparos- copy, and to report on intraoperative findings and surgical procedures. The main I. Tompeen et al. DOI: 10.4236/ojog.2025.1510148 1757 Open Journal of Obstetrics and Gynecology

of our study were the absence of anatomopathological confirmation of endometriosis. In 2022, using histopathology as the gold standard in the diagnosis of endometriosis, Gratton et al. [6] found that sensitivity for laparoscopic visuali- zation was 90.1% (95% CI : 81.0 - 95.1), specificity was 40% (95% CI: 23.4 - 59.3), while positive and negative predictive values were 81.0% (95% CI: 71.0 - 88.1) and 58.8% (95% CI: 36.0 - 78.4) respectively; and the accuracy was 77.1% (95% CI: 67.7 - 84.4). In fact, very few files provided this information, which could be explained by patients not performing the anatomopathological examination or not report- ing the results in the files at the post-operative appointment. Excluding cases with- out histological confirmation would have drastically reduced our sample si ze. However, it is important to remember that according to the recent recommenda- tions of the European Society of Human Reproduction and Embryology [7] , a negative histology result does not entirely exclude the diagnosis of endometriosis. Thus, in our study, we considered the visual diagnosis of endometriosis lesions at laparoscopy. The overall prevalence of endometriosis among our study population was 17.2%. This frequency is lower than the 48.1% found by Fawole et al. in 2015 [8] and the 62% found by Janssen et al. in 2013 [9] in Nigeria. The studies carried out by these authors concerned a population with chronic pelvic pain or infertility. In fact, 45 to 82% of women with chronic pelvic pain and 2.1 to 78% of infertile women have endometriosis [10] [11]. In 2016, Prescott et al . [12] found a frequency of 6 %. Indeed, their study excluded infertile women. In Cameroon, in 2007, Mboudou et al. [13] found that 13.5% of women undergoing laparoscopic surgery for infertility had endometriosis. These disparities can be explained by the heterogeneity of the selection criteria for the various studies and the methodology used. With the de- velopment of endoscopic surgery in Sub-Sahelian Africa over the last few decades, we can see that endometriosis is no longer an uncommon pathology in black Af- rican women. The mean age of the participants was 31.9 years (±5 years), with extremes of 20 and 43 years. These results are similar to those found in the African literature [8 ] [13]-[16]. Indeed, endometriosis is a pathology of young women of childbearing age. Single women represented 68% of our sample, while some authors [13 ] [14] found a predominance of married women. The mean age at menarche was 12.28 ± 2.08 years. Early menarche, defined as occurring at an age of 11 or 12 years or younger, depending on the author, is associated with a higher risk of endometriosis [17] [18]. Nulliparous women were the most represented group (61%), with only one participant being multiparous. Existing studies [14] [19] found a predominance of nulliparous women. Endometriosis is recognized as a cause of infertility through several mechanisms, including impaired folliculogenesis, poor oocyte quality, im- paired ovarian reserve, anatomical changes due to adhesions, a lack of exposure to sexual activity in women with chronic pain, and local proinflammatory factors, which reduce implantation rates and promote early abortion. In our study, patients’ main complaints were infertility (61%) and chronic pel- I. Tompeen et al. DOI: 10.4236/ojog.2025.1510148 1758 Open Journal of Obstetrics and Gynecology vic pain (53%), which was most often cyclical. Pelvic pain and/or infertility are the primary manifestations of endometriosis. These findings corroborate those of sev- eral authors [8] [9] [13] [14] [16], who have shown that chronic pelvic pain and infertility are the primary manifestations of endometriosis. The majority of pa- tients have normal physical findings, and the perception of an adnexal mass on vaginal examination was the most frequently detected physical sign (30% of par- ticipants). This could be explained by the fact that our study included patients with various clinical suspicions and operative indications. This makes searching for physical signs specific to endometriosis suboptimal. Additionally, clinical find- ings differ depending on whether they are sought during or outside of menstrua- tion. It should be noted that these signs are more visible during menstruation. Three of our patients presented with umbilical nodules, which are a s ign of cuta- neous endometriosis. The clinical manifestation of cutaneous endo metriosis de- pends on the hormonal environment and is often associated with catamenial hem- orrhage [20]. Serum Cancer Antigen 125 (CA 125) essays were performed by 14% of parti c- ipants, with elevated levels found in over three-quarters of cases (77.8%). In 2012, Szubert et al. [21] in Poland also found higher serum CA 125 levels in women with endometriosis. CA 125 can be used to improve diagnostic accuracy for endome- triosis, and to assess the efficacy of surgical treatment and the progression towards malignant transformation. However, the sensitivity of CA 125 alone is unsatisfac- tory, because elevated levels are seen in several physiological or pathological situ- ations, such as ovulation, menstruation, ovarian cysts, pelvic infections, and can- cers of the ovary, pancreas, and lungs [22] [23]. A pelvic ultrasound was the most common morphological examination, performed on 34 out of 64 patients (53.1%). Potential reasons to explain this low rate are direct referral for emergent laparoscopy based on clinical presentation or patient finan- cial barriers. The main ultrasound finding was the presence of ovarian cysts (60%). These results are consistent with those of Bilkissou et al. [14], who found that 69.8% of patients underwent pelvic ultrasounds, with endometriomas being the primary finding in 25.3% of cases. Pelvic ultrasound is accessible and is often used as a first- line procedure for pelvic gynecological diseases, including endometriosis. Moreo- ver, endovaginal ultrasound has a sensitivity of 81% - 84% and a specificity of 90% - 97% for diagnosing endometrioma [24]. A pelvic MRI was performed on 11 p a- tients (17%). Most of them showed deep endometriosis lesions. The sensitivity and specificity of MRIs for diagnosing and evaluating deep endometriosis lesions preoperatively are 88% and 99% [25] [26], respectively. However, the high cost of this examination and the limited number of radiologists who specialize in endo- metriosis may restrict its use. The main indications for surgery were infertility (34.4%), chronic pelvic pain (32.8%), and ovarian cysts (17.2%). In 2018, Hemmert et al. [27] in the USA found that the main indications were pelvic pain (63%), pelvic masses (1 4%), and men- strual irregularities (10%). Infertility accounted for only 4%. Schliep et al. [19] also found pelvic pain (62.2%), pelvic masses (12.8%), menstrual irregularities (8.8%), I. Tompeen et al. DOI: 10.4236/ojog.2025.1510148 1759 Open Journal of Obstetrics and Gynecology and infertility (7.4%). These differences may be explained by the fact that all of these studies included patients who had undergone laparoscopy for various rea- sons and for whom endometriosis lesions had been identified. The ovary was the most affected organ (75%). Mboudou et al. [13] and Ajani et al. [15] also fou nd the ovary to be the most affected organ in 35.8% and 58.8% of cases, respectively. Superficial endometriosis lesions were the most frequent (67.2%). These resu lts differ from those of Bilkissou et al. [14], who found endometriomas (22.9%) and adhesions (14.5%). According to the rASRM classification, most of our patients (51.6%) had severe endometriosis. Chapron et al. [28] in France in 2003 found mild endometriosis in most cases (38.1%). This difference may be explained by the fact that their study only included patients with deep endometriosis lesions, whereas the rASRM classification is not the most suitable for deep endometriosis, as it does not take into account the involvement of sites such as the uterosacral lig aments, vagina, rectum, and bladder. Its scoring system prioritizes adhesions and ovarian disease, thereby underrepresenting the functional impact of deep infiltrating nod- ules. The type of surgical treatment depends on the clinical form of endometriosis and the number and location of the lesions. The most common procedure for treating superficial endometriosis lesions was ablation by fulguration. Ablation is indeed a destructive technique recommended for treating superficial endometriosis lesions; however, the main drawback is the thermal damage associated with the diffusion of heat laterally and at depth. The endometrioma was systematically drained, fol- lowed by shell excision in 82% of cases. Exeresis of the cyst is associated with a lower risk of recurrence than ablation. However, a greater or lesser portion of ovarian tis- sue may be removed, especially in endometriomas larger than 60 mm [29]. Surgery for deep nodules most often involved total resection of the nodules (68%). This aligns with the literature [29] [30]. Surgery should be considered only in patients with symptoms that do not respond to medical treatment and significantly impact the quality of life [31] . The current recommendations for the management of endometriosis suggest medical therapy as the first line, including combined hormonal contraceptives and progesterone. The second line consists of Gonadotropin-releasing hormone (GnRH) agonist, GnRH antagonist, and aromatase inhibitors [31]. 5. Conclusion This study highlights the clinical, laparoscopic, and therapeutic aspects of endo- metriosis among women undergoing surgery at the Yaoundé Gyneco-Obstetric and Pediatric Hospital (YGOPH). The prevalence of endometriosis in our popu- lation was 17.2%, with infertility (59.4%) and chronic pelvic pain (53%) as the predominant symptoms. Sociodemographic findings align with existing literature, emphasizing endometriosis as a condition affecting young, predominantly nullip- arous women of reproductive age. Despite the absence of routine h istopatholog- ical confirmation, laparoscopic visualization remained a reliable diagnostic tool, I. Tompeen et al. DOI: 10.4236/ojog.2025.1510148 1760 Open Journal of Obstetrics and Gynecology consistent with recent ESHRE guidelines. Imaging modalities such as pelvic ultra- sound and MRI proved valuable, though accessibility and cost limit MRI’s wid e- spread use in our setting. Surgical management, tailored to lesion type and sever- ity, predominantly involved fulguration for superficial lesions and cyst excisio n for endometriomas, reflecting global standards. The study underscores the grow- ing recognition of endometriosis in Sub -Saharan Africa, driven by advance s in endoscopic surgery. However, challenges persist, including limited diagnostic re- sources and heterogeneity in clinical presentation. Future efforts should prioritize multidisciplinary approaches, standardized protocols, and increased awareness to optimize early diagnosis and treatment, ultimately improving quality of life for af- fected women. To enhance clinical outcomes in our region, we recommend the de- velopment and implementation of standardized diagnostic and treatment protocols for endometriosis. Conflicts of Interest The authors declare no conflicts of interest regarding the publication of this paper.

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